2023 Global Health Care Outlook
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2023 Global Health Care Outlook
2023 Global Life Sciences Outlook Contents Outlook & Overview 3 Virtual health delivery 5 Digital transformation 10 Health equity 18 Workforce 28 Sustainability 36 Contacts 43 Learn more 45 Endnotes 46
2023 Global Life Sciences Outlook Overview & Outlook The COVID-19 pandemic permanently changed global health care, from accelerating the adoption of new technology and care delivery models to increasing the focus on sustainability and resiliency. At the same time, it accentuated existing workforce challenges and the global disparities of health equity. With more than 70 percent of the world’s population having received at least one COVID-19 vaccine, the sector now faces critical questions that will shape it’s future in 2023 and beyond. In the coming year, health care providers, other sector participants, governments, and regulators must ask themselves how they can: • Translate lessons about virtual health delivery during the pandemic into improved access and treatment. • Leverage technology to reduce costs and demands on health workers while improving care for patients. • Reduce their carbon footprint and thereby help to mitigate some of the environmental threats to public health. • Ease the burdens on an increasingly stressed workforce by reshaping the scope of job requirements, allowing more remote work, and providing better support such as mental health services. • Better prepare facilities, supply chains, and partnerships for future pandemics, public health events, or natural disasters. COVID-19 has not disappeared from the global stage, but public health professionals are increasingly optimistic that the pandemic is becoming endemic, meaning that while the virus is still present, it is becoming more manageable and predictable — more like the seasonal flu. While several hundred thousand new infections — and hundreds of deaths — were being reported daily worldwide at the end of 2022, new vaccines have reduced the number of deaths dramatically. During 2022, no new strains were declared a “variant of concern” by the World Health Organization. Health care stakeholders should remain alert, nimble, flexible, and prepared for spikes and valleys in COVID-19 cases as well as other communicable diseases. At the same time, COVID taught health professionals how to adapt to remote working, virtual doctor visits and shortages of medical supplies, personnel, and services. Indeed, the lasting impact of COVID-19 may be one of opportunity in which the health sector has a chance to reinvent itself and capitalize on trends that were emerging even before the pandemic, such as shifting consumer preferences, changes in patient behaviors, and rapidly evolving technology. The sector also should continue to explore clinical innovation and new care delivery models — some of which, like telemedicine, were successfully used on a widespread basis during the pandemic. If the health sector takes advantage of these opportunities, it could transform care delivery, the patient experience, and ways of working at hospitals and other facilities, while also reducing inequities and boosting resiliency. In this 2023 outlook, we review the five key areas that are critical to this transformation, and we pose questions and suggest actions that professional can take to lead this transformation (Figure 1).
2023 Global Life Sciences Outlook
2023 Global Health Care
Sector Outlook
Virtual health
delivery
Workforce
Digital
transformation
Health equity
Sustainability
2023 Global Health Care Outlook | Virtual health delivery Virtual health delivery COVID-19 raised new concerns about the sustainability of current health care models, particularly fee-for-service systems. By its nature, fee-for-service means waiting for patients to get sick, which can be expensive for providers and potentially harmful for patients. The pandemic revealed how quickly fee-for-service systems can be overwhelmed. At the same time, the pandemic demonstrated new ways that remote interactions can improve patient care and lower costs for providers — in both everyday care and potentially during the next health crisis. Virtual health offerings — which range from technology that enhances care coordination and patient education to telehealth and care-at-home — incorporate digital capabilities that address a range of challenges confronting the health care ecosystem, including health equity, the rising cost of care, and workforce shortages. In addition, virtual health capabilities have the potential to transform care delivery worldwide.¹ More importantly, COVID-19 has accelerated the health care sector’s interest in — and the public’s acceptance of — virtual health, largely out of necessity. Mental health is a good example. The pandemic pushed many mental health treatments to virtual settings, and it turned out many patients preferred that. In the future, interconnected systems and always-on data collection will enhance collaboration among health care participants, and treatments will become more precise yet less complex, less invasive, and less expensive.² Investment in this new future of health care has already begun. Spending on virtual health was expected to rise by 39 percent in 2022, based on a survey of industry CIOs and technology executives, as providers look to focus health care on outcomes and value.³ While patients’ appetite for virtual health tools has increased steadily in recent years, some physicians are unsure about how to best use the technology in a clinical setting. Others worry about losing the human connection that is integral to in-person care and patient-doctor relationships. Quite simply, virtual health has the potential to inform, personalize, accelerate, and augment people’s ability to care for one another. Virtual health can only be effective if it retains a human element to care delivery. Patients must see it as an enhancement to care, rather than an impersonal impediment. Striking this balance will require input from physicians, frontline clinicians, and patients.4 5
2023 Global Health Care Outlook |
Virtual health delivery
The potential of virtual health
Virtual health delivery care goes beyond simply enabling video visits or teleconferencing appointments. It can complement
or even substitute for, in-person care. Its primary goals are to expand patient and physician access to critical health services,
improve clinical outcomes, increase consumer engagement, enhance care coordination, reduce costs, and improve efficiency
across the continuum of care.
These can include direct interactions between providers and patients (direct-to-patient care) and technology such as
telestroke, e-ICU, and specialist consultations in which information is shared among providers (provider-to-provider care).5
One of the first steps toward embracing virtual health is the adoption of electronic health records (EHR), which can provide a
more comprehensive picture of population — as well as individual — health.
However, the health care sector must build on this foundation and leverage additional technologies to improve health care
delivery and drive innovation. Virtual health offers the potential to provide patients with better access and preventive care that
can keep them from getting sick.
In addition to improving delivery and patient health, virtual health solutions have the potential to address some of the biggest
challenges facing health care, including:
• Health equity. Virtual health can be intentionally designed to offer more equitable access to diagnosis and treatment for
vulnerable and underserved groups.
• Cost of care. Remote monitoring for prevention and early intervention can slow or reverse mounting care costs.
• Environmental impact. A virtual setup can reduce the need for single-use products. Virtual health has the potential to
adapt to changing environmental circumstances while providing optimal care. By reducing the need to transport patients to
different locations, it can reduce waste and pollution.
• Workforce. Highly skilled clinicians and specialists can reach a broader base of patients and operate at the top of license
by allowing them to focus on care and shed administrative duties. In the short-term, virtual health can address clinician
burnout. Remote work can allow providers to diagnose and treat many conditions in a work-from-home environment, which
can reduce job-related stress. In the future, hospitals can provide care via remote clinical and non-clinical staff.
• Regulatory. Virtual health and emerging technologies can improve regulatory outcomes, such as the vaccination monitoring
used by regulators during the COVID-19 pandemic. At the same time, the digitalization in health care facilities and the shift
to EHRs will come with increased scrutiny. In the US, data storage vendors must demonstrate a specified level of latency and
responsiveness. Other countries require that patient data cannot be stored beyond their sovereign borders.
The benefits of virtual health
The virtualization of care has both changed the nature of care delivery itself and attracted new market participants. Larger
providers have been investing in small health firms. The Mayo Clinic and Kaiser Permanente invested $110 million into
Medically Home Group, a hospital-at-home venture company.6
At the same time, virtual health has drawn the attention of technology and retail giants, including consumer electronics retailer
Best Buy, which in November 2021 paid $400 million for Current Health, a virtual care solutions provider.7 Apple8 collaborated
with Zimmer Biomet to develop remote sensors that work with smartphones and smart watches to track patients’ recovery
from knee replacement surgery.9
As more digital health technology is incorporated into clinical processes through cloud computing, machine learning, and
internet-connected devices, it can significantly reduce care costs. In one study, an insurer found that digital health technology
reduced emergency-room utilization by 9 percent and inpatient admissions by 17 percent, resulting in overall savings of $641
per member each month.10
In addition, technology offers a solution to the shortage of critical care physicians. Japan’s Showa University Hospital, for
example, is using e-ICU intensive care units with remote care centers via on-demand, two-way, audio-visual communication.
The connection allows patients’ bedside care team to consult with the e-ICU clinical team.11
6
2023 Global Health Care Outlook | Virtual health delivery
Similarly, in 2021, Deloitte collaborated with Haryana’s Karnal district located in India to reduce the burden on the health
system through an “extend the hospital ward” program that provided virtual, in-home care facilities for people in rural areas
who demonstrated mild COVID-19 symptoms.12
Technology also creates greater flexibility. Patients and providers can choose a hybrid delivery model that combines the
attributes of in-person and at-home care. In an innovative primary care model, an advanced care team of clinicians with two
or three medical assistants conduct in-person patient visits, which allows providers to use clinicians more efficiently. In early
demonstrations, patient, staff, and physician satisfaction has increased.13
In Switzerland, where home care is well established, providers are experimenting with the next level of remote care: Hospital
at Home. Under this model, patients with an illness that usually requires hospitalization are treated at home. They receive
round-the-clock monitoring and supervision through wearable sensors and devices, doctors communicate via telemedicine
technology, and specializing nursing staff provides in-person visits as needed.
Hospital-at-Home technology also can complement existing treatment, such as major surgery that still must be done in
a conventional hospital (Figure 1). By offering patients the option of recovering from major surgeries at home, the service
improves the healing process for patients and reduces the cost of long hospital stays for providers.14 The entire process is
conducted in collaboration with pharmacies, insurers, and other stakeholders.
Figure 1. Climate change is a universal comorbidity
Hospital at Home is an extension of standard home care: Patients with an illness that usually requires
hospitalization are treated in their home environment. The decentralized concept places the patient at the center
and requires cooperation between different stakeholders such as hospitals, doctors, pharmacies, and
insurance companies.
Hospital at Home
24/7 supervision with Physical visits by
sensors/wearables specialized
nursing staff
Data exchange between Telemedical
all stakeholders exchange with
involved hospital doctors
Collaboration with health
insurance providers
Source: Deloitte analysis.
7
2023 Global Health Care Outlook |
Virtual health delivery
At-home monitoring systems may also help curtail a flood of demand from an aging global population. For instance, linking
technologies such as smartwatches to remote sensors and monitors could allow this population to age in place, helping reduce
ER visits and improve patients’ mental health and quality of care. As a result, the global market for remote monitoring devices
is expected to grow to more than $101 billion in 2028 from about $30 billion in 2021, or 18.9 percent annually.15
By 2024, Deloitte predicts that almost 440 million consumer health and wellness wearable devices will ship worldwide – as
health care providers become more comfortable using them. These numbers include both smartwatches, which are marketed
to and purchased by consumers, and medical-grade wearables—typically called “smart patches”— that are both prescribed by
health care professionals and available off the shelf.16
While mental health services were seen at the forefront of virtual health during the pandemic, they also are finding a growing
following among mobile users.17 Apps are seen helping to manage mental health conditions such as anxiety or depression,
and they can work in conjunction with more traditional therapies by providing a channel for accessing support from a mental
health professional through live chat, video, or telephone. These apps also help improve general well-being by encouraging
behavior change, such as practicing mindfulness and meditation.
As many as 20,000 mental health apps currently are available, and many mental health app developers are launching
collaborations with other online services and apps, such as Snapchat and Bumble, which will expand their reach with
consumers.18
Deloitte predicts that global spending on mobile mental health applications, which surged 32 percent annually — to $269
million in the in the first 10 months of 2020 from $203 million for the same period in 2019 — will continue to increase at about
20 percent a year (Figure 2).19
Figure 2. Global Spending on mental health and well-being mobile apps, 2019-2022, US$ millions
500 491
400
372
300
269
203
200
100
0
2019 2020 2021 2022
Note: Spend estimates for 2021 and 2022 are predictions.
Source: SensorTower, Mobile Wellness Market Trends 2021.
8
2023 Global Health Care Outlook | Virtual health delivery Implementing virtual health If virtual health is going to transform how care is delivered, it must be developed with input from clinicians. Virtual health must be more than just a tool, it must represent a new, interactive, comprehensive, and expansive approach to care delivery. Before the industry can fully embrace the benefits of virtual health, however, it must better assess overall population health and improve collaboration among institutions to build and share data more quickly. Part of the reason for the delay of this fundamental step is a lack of agreement on who should lead the efforts — government agencies, insurers, or private companies? In addition, providers must have the incentives to make the necessary investments, which will require them to determine additional revenue from those investments. In addition, if virtual health is going to transform how care is delivered, it must be developed with input from clinicians. Virtual health must be more than just a tool, it must represent a new, interactive, comprehensive, and expansive approach to care delivery. However, there is one ingredient that essential to any form of digital engagement, and it’s vital for virtual health: trust. The health care industry has historically struggled to achieve a consistently high level of trust, especially among racially and ethnically diverse populations. Providers can enhance trust in virtual health by partnering with community organization to ensure care delivery is meeting the needs of local populations. Care delivery should be designed with input from diverse populations, and it should rely on delivery channels that can reach those populations.20 In the future, these emerging technologies will combine into a tier-based system of care, with each level designed to address different degrees of medical acuity. Questions for providers Assessing where providers stand today in terms of embracing virtual health is essential in building predictive tools to define and investment to fund future capabilities. Executives must ask themselves key questions, such as: • How do we best integrate with EHR companies? • How can virtual health needs integrate with the patient record and the patient and clinician experience? • Is patient choice the correct strategy? What if patients never want to come back to the doctor? • Can we use second opinion choice to expand internal care offerings? Questions for health leaders to consider in adopting virtual health delivery Virtual health delivery is not a substitute for traditional care. Instead, it offers new ways of care delivery that were not possible in the past. In adopting virtual health, organizations should consider the following steps: • Educate, support, and equip physicians to infuse the human element of care in virtual health encounters • Rethink existing care models and assess how to prioritize virtual health investments for future care models • Ensure virtual health is accessible to, and meets the needs of, all patient populations • Develop a thorough understanding of the human experience of receiving and providing care, apply a thoughtful approach to workflow redesign, technology applications, and the use of care teams, and follow a careful change management plan • Involve physicians, patients, and other care team members, and value their input while designing and implementing human- centered virtual health offerings and workflow processes • Consider regulatory and policy issues that may impact your model, advocate for flexibility in virtual health design, and support associated adequate reimbursement 9
2023 Global Health Care Outlook |
Digital transformation
Digital transformation
The COVID-19 pandemic overwhelmed health care systems worldwide, resulting in a surge in the number of patients, increased
health care demands, labor shortages, and supply chain issues. Providers turned to technology as one solution to help address
these challenges.
Providers who had been slow to embrace technologies such as telemedicine and electronic health records (EHRs), are now
accelerating adoption of new technology as they attempt to reduce costs, deal more effectively with the changing patterns of
demand, address a shrinking clinical workforce, and prepare better for the next global health crisis.
At the same time, one in three adults worldwide have chronic conditions that increase the burden on health care systems,
one in four will experience mental illness during their lifetime and more than 75 percent of health consumers expect more
accessible personalized care.1 The cost of this care will be significant — for mental health alone the cumulative loss in
economic output over a 20-year period ending in 2030 is projected to be US$16.3 trillion.2
But health care capacity remains constrained by fragmented funding and reimbursement practices, outdated treatment
models, excessive administration, inefficient processes, and labor shortages.
As much as US$935 billion, or 25 percent of all US health care expenditure, is wasted, primarily on administrative complexity,
pricing failures, and poor care delivery.3 In addition, 42 percent of physicians report feeling burned out, and health care
providers face a global deficit of 12.1 million skilled professionals by 2035.4 As a result, more providers are looking to digital
technology to boost efficiencies and lower the cost of care.
Deloitte US consumer surveys show that during the past five years, patients‘ appetite for virtual and digital health tools has
steadily increased, but adoption rate among physicians is mixed (Figure 1). Some are unsure how to best use virtual health in a
clinical setting while others are concerned about losing the human connection that is an integral part of in-person care.5
102023 Global Health Care Outlook |Digital transformation
Figure 1. Adoption of video visits increased, but adoption of other virtual health modalities stalled.
Which of the following virtual health approaches have you implemented at your primary work setting? (respondents selected
all that applied.)
2018 2020 2022
14%
Video visits 19%
67%
N/A
Chat with patients through
N/A
digital app or texting
30%
17%
Physician-to-physician
22%
virtual consultations
23%
N/A
Patient reported outcomes
20%
through a digital application
11%
Remote patient monitoring at 6%
otherfacilities or departments, 13%
such as ICUs or SNFs 11%
6%
Remote patient
12%
monitoring at home
6%
N/A
Chatbots or virtual assistants that
N/A
answer common patient questions
4%
Integration of data from 5%
patient wearables into 10%
patient’s medical records 4%
Notes: Skilled nursing facilities (SNFs): wearables (where the data is collected passivley from fitness, sleep quality, basic heart-rate activity and other
consumer health-tracking devices): physician -to-physician virtual consultations (virtual communication tools or portals forphysicians to consult with each
other about a patient): patient-reported outcomes (where the patient actively submits the data through a digital app or text messages). N(2018) = 624;
N(2022) = 660
Source: Deloitte survey of US Physicians conducted in 2018, 2020 and 2022.
112023 Global Health Care Outlook |
Digital transformation
One of the silver linings of COVID-19 was that it accelerated advances in digitization and telemedicine that previously were hard
to be accepted by either patients or clinicians.
For example, in the UK, efforts to develop a framework for virtual consultations, which had languished for years, have
advanced because of COVID-19-related staff shortages and Brexit work restrictions. The National Health Service (NHS) plans to
have 40 to 50 virtual ward beds per 100,000 people by 2023.6
Even as lockdowns and other restrictions have lifted in many parts of the world, the use of telehealth remains above its pre-
pandemic levels. For example, Kaiser Permanente found that 15 percent of its members in the US used virtual consultants
before the pandemic. After reaching a peak of 80 percent during the outbreak, it is now about 35 percent. Similar patterns
have emerged in Europe and Asia. The European Parliament recently announced the EU4Health program, which encourages
the sharing of EHRs, e-prescriptions and telehealth. Saudi Arabia is adopting a system that uses smartphone applications to
connect patients in remote areas with primary care centers and hospitals.7
For some specialties, notably mental health, virtual care remains popular because of its convenience, flexibility and user
experience for both clinicians and patients alike. Eighty-nine percent of mental health consultations are conducted virtually,
and well-designed virtual care models have been found to have comparable clinical efficacy to face-to-face contact — in some
cases delivering superior outcomes and patient satisfaction.
Patients in many countries have become more comfortable with managing their own pathways to care. The widespread use of
home COVID-19 tests and vaccination scheduling and reporting has made many people more comfortable with self-testing for
other types of diagnostics and screenings as well.
In this post-pandemic era, more than 40 percent of patients have expressed a desire to continue to use telehealth (Figure 2).8
This demand will encourage health care providers to invest in digital transformation to connect patients with personalized
services that suit their needs and preferences.
These interconnected systems can enable patient choice and control, improve health delivery, increase greater access, make
administration faster and more efficient, and lower costs.
Figure 2. Consumers who have had virtual health care visits over the past year intend to keep using virtual or
hybrid options for some future health care needs.
When the COVID-19 pandemic eases what would be your preferred way to attend appointments for the following?
Completely virtual Mostly virtual Even blend of virtual and in-person
Mostly in-person Completely in-person Dont know/Not applicable
Checks for chronic /ongoing conditions
8% 15% 22% 24% 27% 4%
Checks for new symptoms and issues
6% 14% 22% 27% 29%
Checks for emergency issues
5% 8% 13% 21% 50%
Regular full-body checkups (e.g.,annual physical exam)
5% 7% 12% 24% 50%
Notes: Respondents represent people who attended at least one virtual health care appointment (as a patient or with a patient) in the last year.
Source: 2022 Connectivity and Mobile Trends, 3rd edition.
122023 Global Health Care Outlook |Digital transformation Understanding depths of digital transformation Many countries are making progress in adopting EHRs. The NHS, for example, plans to adopt electronic health records (EHRs) at all hospitals and community practices in the UK by 2025.9 While this provides a strong digital backbone, the challenge in many countries is interoperability — getting related hospital systems to link with each other — and extending those connections to external services such as primary care centers. In addition, the quality and comparability of the data is inconsistent. Unstructured or “dirty” patient data can provide an incomplete picture of a patient’s health. Most organizations are adopting standard data sets, building data “lakes” to combine data, and using the latest artificial intelligence (AI) tools to develop meaningful insights. Despite this, in many countries, vital medical information is still stored on paper. When information or images are shared, it is often done by fax, mail, social messaging applications, or patients themselves, who carry their physical documents from one provider to the next. The advent of Health Information Exchanges (HIEs), in which health care organizations can exchange electronic health information, is growing rapidly. New payment and reimbursement approaches are increasing the focus on care coordination. For example, HIEs can help providers avoid unnecessary readmissions and medication errors, improve diagnoses, and decrease duplicate testing.10 The exchanges are standardizing technology to allow providers and patients to connect more effectively and allow care to be distributed more broadly across multiple care pathways, care settings, and geographical regions. Finland, for example, has already established a process for sharing EHRs on a regional basis. The gold standard for digital health, however, is Estonia. Estonia’s health service has been digital for 12 years, and more than 99 percent of the data generated by doctors and hospitals is electronic. Residents can access their medical records via online portals, and video consultations and e-prescriptions are common practice. Not only do patients renew their prescriptions without visiting a doctor in person, but they also don’t have to go to the pharmacy, either. Most prescriptions are delivered to patients’ homes.11 Meanwhile, the US Department of Health and Human Services is calling for a nationwide, interoperable health IT ecosystem by 2024 that would provide health data across products and organizations in a way that could be more meaningfully used by recipients. The system would be continuously updated and give consumers the ability to share information securely with their providers of choice. It is designed to lower costs, improve population health, drive innovation, and empower consumers.12 Heading to the cloud Financial pressures are a double-edged sword in the digital transformation of health care. On the one hand, technology can improve efficiency and reduce costs. On the other, the expense of moving systems to new digital platforms can slow the adoption of cloud solutions. In the UK and Scandinavian countries, concerns about margin pressure are driving digitization, yet in the US and Australia we see margin preservation restricting the adoption of new technology. In response, pricing is becoming subscription- or usage- based and is moving from capital to operating expenditures. Deloitte, for example, has formed a partnership with Amazon Web Services (AWS) to use third-party data in the cloud to create an efficient, robust, and secure health care data ecosystem that can improve population health, reimbursement and provide other real-world insights.13 Nevertheless, most health executives recognize the longer-term benefits of digitization. A survey of almost 400 health executives across six countries found that two-thirds of respondents expect to move their IT infrastructure to the cloud within a year, and 96 percent expect to do so within three years.14 Much of the focus around digitization has been on operations — specifically, the managing and delivery of care — but, technology, and specifically automation, is also reducing costs and improving back-office processes such as clinical coding, billing, scheduling, payroll, and procurement. 13
2023 Global Health Care Outlook |
Digital transformation
COVID-19 accelerated the shift to cloud-based technologies designed to strengthen business operations and drive more
customer interactions into the digital realm. This trend is forcing the large EHR providers to migrate their products and
services to the cloud and develop partnerships with Customer Relationship Management (CRM) and Enterprise Resource.
Planning (ERP) providers.
In June 2022, for example, Oracle completed its acquisition of Cerner with plans to expand Oracle’s cloud business in the
hospital and health system market, both in the US and internationally. Oracle said the acquisition will enable it to provide a
new generation of information to health professionals that will improve treatment decisions and patient outcomes while lower
providers’ administrative workload, enhancing patient privacy and reducing costs.15
CVS Health and Microsoft announced a new strategic alliance in December 2021 to develop innovative solutions that will help
consumers improve their health. The collaboration is designed to allow CVS Health to provide a data-driven and personalized
customer experience to clients.
Cigna began using the cloud platform from Majesco’s L&A Group for its supplemental health solutions product suite in July
2022 after partnering with Majesco a year earlier to accelerate its digital transformation.16
In addition, many venture capitalists, private equity firms, and health care organizations are investing in startup platforms.
Globally, health-tech investments in 2021 topped $44 billion, double the previous year (Figure 3).17 Large tech-enabled
platform companies could help hospitals and health systems improve efficiencies and scale quickly by modernizing existing
systems and delivery models, addressing health-equity through a platform approach.18
Figure 3. Health tech investments continue to grow at an unprecedented pace
Health tech venture funding (in US$ billion)
29.1
14.0.
8.2
7.4
5.8
4.7 4.6
4.1
2.1
1.5
1.1
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Source: Deloitte analysis of Rock Health Digital Health Funding Database
142023 Global Health Care Outlook |Digital transformation However, migrating to the cloud can raise environmental concerns. Some estimates show that cloud-based computing generates a larger carbon footprint than the airline industry—and that a single data center can consume as much energy as 50,000 homes.19 As more companies assess their indirect, or Scope 3, emissions, they must gauge the carbon footprints for partners, suppliers, vendors, and other third parties. AWS, Google Cloud, and Microsoft Azure all have introduced tools to help customers assess their carbon footprints and take steps to reduce them.20 Deloitte is collaborating with the International Hospital Federation to develop a dashboard for health care organizations to assess their carbon footprints. The Sustainability Accelerator Tool has been released in a beta version. Learn more about the tool in the Sustainability section of the outlook report. Emerging technologies Emerging technologies such as AI, telehealth, blockchain, and monitoring devices, such as sensors, wearable and ingestibles, are providing real-time and continuous data about our health and our environment. This is redefining the future of health care and health delivery. Health care companies can use these innovations to provide more accurate diagnoses, deliver personalized treatment and predict risk or deterioration and intervene early. Telehealth became widely accepted during the pandemic, and it continues to evolve, incorporating patient portals, telemedicine, mobile health, video conferencing, and remote patient monitoring. Already, patients are frequently using portals to schedule appointments and receive test results via their smartphones, and telehealth applications are expected to expand during the next five to 10 years. Almost half of consumers said they attended at least one virtual medical appointment in 2021. While many cited avoiding COVID-19 as a primary reason for embracing the technology, they also found it more convenient because they could choose an appointment time that better fit their schedules. Ninety-two percent of those who used virtual appointments said they were satisfied with them, and 48 percent said they were very satisfied.21 AI can work in conjunction with data such as EHRs stored on the cloud to develop a system of proactive continuous care designed to keep people well rather than episodic care delivered retrospectively when they are already sick. A new AI- empowered system at Johns Hopkins Health System scours medical records and clinical notes to identify patients who might be at risk of infection before symptoms develop. A study conducted by the health system found that patients are 20 percent less likely to die of sepsis because of the new tool.22 AI4HealthCro, a not-for-profit public-private consortium based in Croatia, is developing AI technologies for the European Union that it estimates will free up as much as 1,944 man hours annually, save as many as 403,000 lives, and reduce health care costs by as much as €212.4 billion.23 Not all health conditions or concerns require an in-person consultation with a clinical professional. AI is increasing patients’ options for receiving health care. Algorithms can diagnose and provide personalized advice and support to patients in automated channels such as call centers, text messaging, chat bots, and video consultations. According to Kaiser Permanente, 75 percent of enquiries are resolved in one visit using these remote channels. One study, conducted in an urgent care setting in Sao Paulo, Brazil, during the pandemic, found that the implementation of an AI registration system cut down wait times by an average of 12 minutes and saved more than 2,500 hours a year in employee time.24 AI already is being used to improve diagnostics and make predictive medicine more accurate. Researchers at Google’s DeepMind Health designed an AI algorithm that could identify factors for when someone was at risk for advanced kidney failure — and predict it 48 hours in advance. Overall, the algorithm had an accuracy rate of 55.8 percent, but in cases severe enough to later require dialysis, its prediction were accurate 90.2 percent of the time.25 Whilst these new channels of advice and treatment have the potential to increase patient access, operate around the clock, and reduce the workload on already stretched clinical teams, careful testing and implementation is essential. The quality of the experience can be hampered by poor data quality, low data point counts, and lack of trained personnel for handling these technologies. Moreover, these channels must be synchronous so patients can move freely between them with one record being continuously updated and maintained. The risk is that often, when new technologies are added, they are implemented piecemeal rather that integrated throughout an organization or across a patient journey.26 15
2023 Global Health Care Outlook |
Digital transformation
Health care providers who use wearable technology to monitor chronic health conditions and to track vitals, sleep quality, and
medications are finding the technology helpful. However, for large-scale adoption clinicians must agree on the parameters for
alerts, appropriate clinical governance arrangements, and efficient work flows alongside effective reimbursement models for
devices and data. Data accuracy and privacy, as well as cyberthreats, will also act as headwinds to adoption.37
Figure 2. Consumers are using their smartwatches, fitness trackers to measure physical activity and health
indicators
In which of the following ways do you use your Which of the following health metrics do you use your
smartwatch/fitness tracker for your fitness? smartwatch/fitness tracker to monitor?
Count steps per day Pulse rate
64% 59%
Motivation to exercise (reminders, badges) Calories and nutrition
36% 42%
Measure speed and distance (GPS) Heart health (ECG)
31% 40%
Store workout data Sleep quality and duration
28% 39%
Track weight loss Breathing rate
27% 30%
Measurement persormance or exertion Blood oxygen level (SPO2)
25% 24%
Plan workouts Body temperature
17% 22%
Follow workouts through an app Stress level
16% 21%
Provide personalized coaching
9%
Notes: Respondents represent consumers who personally own a smartwatch and /or fitness tracker and use it for and/or fitness monitoring
Source: 2022 Connectivity and Mobile Trends, 3rd edition.
162023 Global Health Care Outlook |Digital transformation Questions for providers to consider in approaching the digital transition Answering these questions will help providers prepare for transformative technologies that are coming in the next five to 10 years. These include: • Digital front door— As the primary point of digital engagement, the digital front door consists of multi-channel communications platforms, including web portals, mobile applications, and SMS messaging. It provides multiple stakeholders with access to providers’ digital and analog services. • Autonomous monitoring — Enables patient surveillance through video and sensor technology and deploys AI and behavioral analytics to provide real-time insights and timely medical intervention. • Digital clinical encounters — Offers semi-automated patient interactions with clinical protocols, algorithms, and AI for assessing symptoms, issuing prescriptions and other functions. By using evidence-based clinical knowledge, it reduces clinicians’ direct involvement • Digital health platforms — Allows providers to offer value-based, hassle-free virtual care to patients by addressing health issues through cloud-based platforms and services. 17
2023 Global Health Care Outlook | Health equity
Health equity
Social determinants of health
Great disparities based on age, location, gender, income, race, ethnicity, religion, and sexual orientation persist in the global
health ecosystem despite significant efforts to eliminate them by health care providers, insurers, government agencies, aid
organizations, and others.
More than a quarter of the world’s population has no access to essential medicines, and for more than 2 billion people
worldwide, medicines may be unaffordable, unavailable, inaccessible, or of poor or unregulated quality.1
Income, education, and living and working conditions can shape physical and behavioral health. In many cases, individuals may
have little or no control over factors that can directly or indirectly affect their health — such as living in proximity to lead paint,
polluted air and water, scarce food sources, dangerous neighborhoods, and few outlets for physical activity.
Characteristics such as secure housing, age, ethnicity, gender, and economic resources often correlate to differences in access
to medical facilities and services and variation in the rates of disabilities and disease occurrence (Figure 1).
182023 Global Health Care Outlook | Health equity
Figure 1. The broad social and economic circumstances that together determine the quality of the health of the
population are known as the ‘drivers of health’
Health care organizations can impact DOH for their patients and members, employee populations, and in their larger
communities
Source: Deloitte analysis.
192023 Global Health Care Outlook | Health equity
These social, economic, and environmental “drivers of health,” or social determinants of health, can have a greater impact on
health outcomes than the care provided by clinicians — accounting for about 80 percent of health outcomes.2
The problems are not new. Five decades ago, public health organizations in the US began documenting maternal mortality
disparities between white and Black women. In the ensuing decades, research has developed many other links between these
nonclinical factors and long-term health outcomes.
For example, children who experience stressful circumstances, especially on a daily basis, are more likely later in life to adopt—
and less likely to discontinue—risky health behaviors like smoking and drug and/or alcohol abuse that may function as coping
mechanisms.3 Studies also have found that depriving infants of a loving environment causes lasting damage to their emotional
well-being, intelligence, and development capacity.4
Yet efforts to systemically reduce or eliminate these disparities have proven difficult. This is largely because they require a
coordinated approach not only across government agencies but also across the commercial sector. Early programs such as
the Total Place initiatives in the UK, which was designed to tackle seemingly intractable issues such as teenage pregnancy, did
not necessarily benefit those with the greatest need. Nor was it effective in addressing the root causes of health inequity.5
Many of the disparities such as Total Place and others like it attempted to address have causes that extend far beyond
the health care system, requiring changes in environmental policies, employment practices, training schemes, tax laws,
regulations, and civil rights legislation. They also require breaking down institutional discrimination and prejudices.
The COVID-19 pandemic underscored the pervasiveness of health inequity. The virus disproportionally affected the most
vulnerable groups, and focused public attention on how communities are only as strong as their most compromised
members. As a result, many health organizations are rethinking how to address health inequity.
The growing impact of climate change could further amplify global health inequities by putting clean air, safe drinking water,
adequate food supplies and secure shelter in jeopardy. Rising temperatures are expected to cause about a quarter million
more deaths worldwide from malnutrition, malaria, diarrhea, and heat stress between 2030 and 2050 (Figure 2).6
Figure 2. Rising temperatures multiply the risk to human health
As CO2 emissions rise, the impacts on the physical environment excerbate the other social determinants of health.
Source: Deloitte analysis.
202023 Global Health Care Outlook | Health equity Longevity equity A key measure of health equity is life expectancy. If people living in the same geographical areas have significant differences in the life expectancies, it can spotlight the drivers of health inequities. Ethiopia, for example, has an average life expectancy of 65.6 years, about three years longer than neighboring Kenya.7 In recent years, Ethiopia has adopted community-based health strategies, improved access to safe water, and expanded female education and gender empowerment. Similarly, Brazil has an average life expectancy of 73.4 years, compared with 64.9 for neighboring Bolivia and 70.5 for Paraguay. Brazil has reduced inequality improved female education and health care coverage and expanded political participation.8 Perhaps most alarming, life expectancy in the US has fallen for the past three years — to an average of 76.1 years from 78.8 in 2019.9 In some regions, lower life expectancies can vary by postcode and correspond with higher instances of certain diseases. Environmental factors in these areas can have a significant impact on longevity. For instance, air pollution causes about 7 million premature deaths every year.10 Twenty-three million US homes—the majority of which are in impoverished and marginalized communities of color—contain lead-based hazards.11 Worldwide, household air pollution (HAP) — primarily from a lack of clean energy such as electricity or natural gas for cooking and heating — causes 4.3 million premature deaths annually. HAP contributes to higher levels of strokes, heart disease, lung cancer, and chronic obstructive pulmonary disease in low- and middle-income countries.12 These environmental hazards, combined with limited access to health services are among the reasons that life expectancy in low-income counties can be almost 20 years less than in high-income ones.13 In urban areas, life expectancy can differ by city blocks or neighborhoods, with variance in life expectancy of as many as 25 years. Similar gaps exist in infant mortality, obesity, violence, and chronic disease.14 Quite simply, where a person lives will determine how long they live. Health equity disparities often follow other social and economic divides, especially among racial lines. As of 2020, white Chicagoans were living as much as 10 years longer than Black Chicagoans, and the gap widened from 8.8 years in 2017. For the first time in decades, life expectancy for Black residents of Chicago fell below 70 years. In Australia, the burden of disease for Aboriginal and Torres Strait Islander people is 2.3 times that of non-indigenous Australians. Rates of psychological distress and chronic disease are higher, and health access is lower because of cost and lack of available services.15 The same is true in Canada, where indigenous people have a life expectancy that is 14 years less than non-indigenous Canadians. Twenty-five percent of indigenous Canadians suffer from addiction, compared with 17 percent for the general population. Suicide rates among indigenous youth are six times higher.16 The pandemic added to the health equity divide, affecting access to food, childcare, stable housing, and income. Fifty-nine percent of Black US residents and 50 percent of Latinos held jobs requiring them to work in person at the height of the pandemic when vaccines were not yet available.17 What’s more, two-thirds of low-wage US workers still lack access to paid sick days.18 At the same time, many of these communities have historically been under-diagnosed in terms of common life-threatening diseases such as cardiovascular illness, and many don’t have access to basic care or screenings for heart attacks, cancer, obesity-related health issues, and other ailments. Half of US adults with lower income don’t get needed care because it’s too costly — they often skip visits, recommended tests, treatments, follow-up visits, or prescription medications. In contrast, the number was 12 percent to 15 percent for lower- income adults in Germany, the UK, Norway, and France.19 Indeed, the limited social safety net, market-based health care, limited public health regulation, and increases in health inequity have caused average US life expectancy to fall by almost 3 years.20 21
2023 Global Health Care Outlook | Health equity
Globally, 94 percent of all maternal deaths occur in low-and-middle income countries, but at a time when maternal mortality
has been declining globally, the US was one of only two countries (the Dominican Republic was the other) in which it rose.21
The US maternal mortality ratio of 17.4 per 100,000 pregnancies is the highest among industrialized nations.22
In the UK, poor diet and obesity are two of the main contributors to premature death. Those living in deprived areas often
face significant barriers to accessing affordable nutritious food.23 In India, where longevity is defined by factors such as caste,
religion, and indigenous identity, the poorest households have a life expectancy of 65.1 years, compared with 72.7 years for
the wealthiest.24
Heath justice
Access and care delivery disparities are part of a larger system of prejudice, racism, and bias that pervades the health
ecosystem at many levels. In the summer of 2020, for example, 75 percent of new COVID-19 cases in Saudi Arabia and 95
percent of those in Singapore were migrant workers. This follows a pattern seen in other disease outbreaks in which abuse
and discrimination toward migrants or other nationalities reinforce barriers to health care access.25
Health inequity also influences where facilities are located and gaps in physician training and diversity. Care coordination
algorithms may direct resources to those using the most services, who are disproportionately higher income. This disparity
highlights the health conundrum between health need and health demand.
Unnecessary health care spending from structural inequities and biases is well documented. Research shows that spending
tends to be higher among certain populations because of delayed care, access challenges, missed diagnoses, and limited
access to the latest scientific advances as well as proper preventive services.
Racism and bias also threaten the adoption of new technologies that could provide better care delivery to these underserved
populations. Telemedicine is a key component of the digital transformation of health care since the COVID-19 pandemic, but it
hasn’t been adopted by all populations equally.
In the US, Blacks and Hispanics are 35 percent and 51 percent less likely, respectively, than whites to use telemedicine. Again,
economic and environmental issues come into play. Poorer households are more likely to lack the technology to access
telemedicine. Only one in four families earning $30,000 or less have a smartphone, tablet, or laptop computer, compared with
almost three in four for families earning $100,000 or more. In addition, only 66 percent of Black and 61 percent of Hispanic
households have access to broadband internet, compared with 79 percent of white households.26 In this case, the digital
divide begets a health services divide.
These inequities are not just a public health or social problem, they are also an economic one, potentially adding to cycles of
poverty that reinforce additional health inequities. More than 30 percent of direct medical costs faced by Blacks, Hispanics,
and Asian-Americans in the US can be linked to health inequities.27
Inequity also falls disproportionately on other underserved groups, such as the elderly, mentally ill, and disabled. Worldwide,
disabled people face lower economic participation, higher poverty rates, and increased dependency. Across the 27 countries
in the Organization for Economic Co-operation and Development (OECD), average employment for the disabled was 44
percent, compared with 75 percent for non-disabled people. Worldwide, the disabled face greater food insecurity, poor
housing, and a lack of access to clean water and sanitation. This is especially true in low-income countries, where the disabled
are 50 percent more likely to experience catastrophic health expenditures than non-disabled people.28
222023 Global Health Care Outlook | Health equity
The cost of health inequities
Inequities across the health ecosystem limit underserved people’s access to affordable, high-quality care, create avoidable
costs and financial waste that span society, and impact every individual’s potential to achieve health and well-being.
In the US health system, for example, inequities cost about $320 billion and could exceed $1 trillion in annual spending by
2040 if left unaddressed (Figure 3). This projected rise in health care spending could cost the average American at least $3,000
annually, up from current costs of $1,000 per year.29
Figure 3: Modeling the cost of US health inequities in 2040
Cost of inequities in 2040
$1 trillion
Cost of inequities
$320 million
Expected changes in population
demographics, cost of care and
per capita spending
We initially focused on a set of Using the assumptions from
disease states to establish a these disease states and
baseline for a costs potentially disparities research, we
attributed to inequities & bias extrapulated tp all other disease
states
Note: All values are in US dollars.
Source: Deloitte analysis.
Meanwhile, the European Parliament estimated that health inequities in the European Union cost about 1.4 percent of GDP
each year, almost matching defense spending of 1.6 percent of GDP.30
The pressure to reduce costs
Globally, the health care sector is under pressure to reduce health care spending while increasing quality of care. Persistent
health inequities have a substantial impact on health outcomes and spending. However, the industry hasn’t yet found systemic
and sustainable solutions to address this complex challenge.
To address these disparities, health organizations must work outside of the traditional health care system and address the
social, economic, and environmental factors that lead to healthy or unhealthy outcomes.
There is some light ahead. There are several global initiatives that are committed to making a change.
For example, Google is working with several health care organizations to develop a health equity tracker that can be used to
create actionable, evidence-based policy changes to help disproportionately impacted communities receive equitable.
232023 Global Health Care Outlook | Health equity
The tracker has several key features:
• Highlight the impact of COVID-19 and other diseases on the Black, Indigenous, Latin, Asian, Pacific Islander, and other
vulnerable and marginalized communities
• Record COVID-19 cases, deaths, and hospitalizations across race and ethnicity, sex, and age
• Measure comorbidities associated with COVID-19, including COPD, diabetes, and social and political determinants of health,
including uninsured and poverty rates
The companies are working to expand the tracker’s ability to include additional conditions such as mental and behavioral
health, and social and political determinants of health that impact vulnerable communities, including LGBTQ+ individuals and
people with disabilities and lower socioeconomic status.
In the future, the tracker will also be able to ingest multiple data sets ranging from social and political determinants of health,
demographics, and other variables, creating a novel, comparative approach to assessing and conceptualizing health and social
inequities.31
Some European and Asian experts are taking a more fundamental approach to addressing health equity. In October 2022,
experts from nine countries — Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Tajikistan,
Ukraine and Uzbekistan — met in Tbilisi, Georgia, to examine the level of financial hardship from catastrophic or impoverishing
medical expenses and discuss protections. The group established guidelines for the scope and qualifications of public benefit
packages and processes for countries to identify gaps in health coverage that can lead to financial hardship.32
Addressing health inequity
Achieving health equity requires leaders to design and build systems that advance health equity as an outcome from the
outset and not as an afterthought. To bring greater equity to health care, organization should:
• Dismantle the racism and bias built into the foundation of the health care system over centuries
• Expand access to coverage and care for communities and populations that have historically lacked it
• Look outside of the traditional health care system to address the social, economic, and environmental factors that lead to
healthy or unhealthy outcomes.
In the past few years, health care companies announced various initiatives to mitigate health and social inequities and provide
quality treatment to every individual irrespective of race, ethnicity, socioeconomic status, gender identity, sexual orientation,
or cultural background.
But despite well-intentioned efforts, trust remains an issue. In the past, health organizations often made assumptions on
what their communities needed and wanted, instead of asking. In light of the imperative for health equity, they now have
an opportunity to build trust based on a wide range of perspectives in their communities and direct input from consumers.
Organizations must understand what experiences led to the loss of trust, how they might re-earn it, and how they can prevent
those events from happening again.33
In January 2022, the National Committee for Quality Assurance launched its Health Equity Accreditation Plus evaluation
initiative. The program establishes processes and cross-sector partnerships that identify and address social risk factors in
their communities and the social needs of the people they serve.34
Similarly, the health maintenance organization Oscar announced its Culturally Competent Care Grant program in May 2021.
The grants are focused on providing care to patients with diverse values, beliefs, and behaviors, including tailoring delivery to
meet patients’ social, cultural, and linguistic needs.35
For organizations, addressing biases and advancing health equity is not merely a moral imperative but also a competitive
advantage. Proving the business case and using this as a point of competitive advantage will be critical to sustainable focus
and scale.
By targeting these issues, employers can attract and retain the best talent and elevate their brand and reputation in the
market. What’s more, healthier workers have fewer sick days, are more productive on the job, and have lower medical care
costs.
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